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Vessels around the ureteropelvic junction: significance and imaging by conventional radiology
P J Van Cangh1, S Nesa, M Galeon
1Department of Urology, University of Louvain Medical School, Brussels, Belgium.
Insights
Crossing vessels near the ureteropelvic junction significantly reduce endoureteropyelotomy success rates. Hydronephrosis grade also impacts outcomes, with combined factors influencing recurrence and patient selection for optimal results.
Area of Science:
- Urology
- Surgical Outcomes
Background:
- Endoureteropyelotomy is a treatment for ureteropelvic junction obstruction.
- Prognostic factors influencing success require further elucidation.
Purpose of the Study:
- To investigate the impact of crossing vessels and hydronephrosis grade on endoureteropyelotomy outcomes.
- To evaluate the efficacy of diagnostic imaging for identifying these factors.
Main Methods:
- Retrospective analysis of 86 patients undergoing endoureteropyelotomy.
- Follow-up ranging from 1 to 12 years.
- Assessment of crossing vessels and hydronephrosis grade; comparison of imaging modalities (intravenous urography vs. angiography).
Main Results:
- Crossing vessels significantly decreased success rates (82% without vs. 33% with vessels).
- High-grade hydronephrosis was associated with lower success (54%) compared to low-grade (81%).
- Angiography provided superior diagnostic accuracy over conventional urography.
Conclusions:
- Presence of crossing vessels and high-grade hydronephrosis are critical negative prognostic factors for endoureteropyelotomy.
- Patient selection based on these factors is recommended.
- Development of less-invasive diagnostic methods is needed.
Abstract:
We studied the influence of vessels crossing the ureteropelvic junction and of the grade of hydronephrosis in 86 patients who underwent endoureteropyelotomy. With a follow-up ranging from 1 to 12 years, the presence of crossing vessels had a significant negative influence on the outcome and recurrence rate of the procedure. The success rate was 82% when no vessels were present but only 33% when crossing vessels were documented. In 13 of 15 failures (87%), a crossing vessel was found at open pyeloplasty. The degree of hydronephrosis was a less potent detrimental factor, with an 81% success rate in low-grade and 54% in high-grade hydronephrosis. The best results (90% success) were obtained in patients with no crossing vessels and low-grade hydronephrosis and the worst (30% success) in those with high-grade hydronephrosis in the presence of crossing vessels. Selection of patients according to those prognostic factors is recommended. Conventional intravenous urographic imaging techniques proved insufficient, and only angiography provided diagnostic accuracy; less-invasive methods are desirable.